Home health nurse-managed heart failure protocol to reduce hospital readmissions: a quality improvement project

Abstract

Heart disease is Montana's leading cause of death with an average of 2,245 annual deaths, or 158.9 per 100,000, from 2014 through 2021 (CDC, 2022). Hospitalizations and unplanned readmissions for HF are costly for healthcare systems and decrease patient quality of life. Home health nursing services have been proven to decrease unplanned HF readmission rates (Bamforth et al., 2021, Li et al., 2021, Maliakkal & Sun, 2014, & Spall et al., 2017). However, the evidence consistently points to a lack of specificity regarding home health nurse duties (Bamforth et al., 2021, Li et al., 2021, & Spall et al., 2017). This review examined the most recent systematic reviews and meta-analyses to find evidence supporting a HF-specific nurse-led protocol, including medication titration and initiation to reduce readmission rates compared to usual care or home health without a disease-specific protocol. In conclusion, a HF-specific, nurse-led protocol is not identified or discussed within the literature. Other chronic illness management has been improved by implementing nurse-led medication standing orders (Shaw et al., 2014). This project will examine the rate of readmissions once a cardiologist-approved HF protocol for patients receiving in-home care has been implemented.